Healthcare Design - December 2018 - 30

In Focus

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expertise and collaborated on how to support
them in the design. For example, MetroHealth
is interested in using automated guided vehicles
(AGVs) in the new hospital. To provide flexibility, the team was challenged to create the
infrastructure in a process-neutral way so that
the facility can perform with or without these
vehicles. The solution was to incorporate space
directly off supply corridors for robot loading,
charging, drop-off, and parking, with spaces
placed and sized to support either manual or robot delivery.
Through intensive pre-design workshops, the
team also examined space utilization to identify how to quickly adapt rooms to new delivery
methods and processes, focusing on eliminating
over-specialized spaces. Team
members looked for synerUNIVERSAL CONCEPTS
gies between clinical service
areas and operations to think
MUST ALSO SUPPORT
more universally about design,
PATIENT EXPERIENCE.
grouping similar work functions with similar work spaces
to create a series of clinical platforms. One such
example is a 90-patient, short-stay platform
developed to accommodate all surgical, procedural, and medical observation patients as well
as the post-anesthesia care unit. By combining
these functions in one space, the design eliminates redundancies related to time-of-day and
day-of-week utilization swings, resulting in approximately 15 percent fewer treatment spaces.
However, to design for the highest need, some
spaces are oversized by as much as 10 percent to
create flexibility.
Brent Peterson, senior industrial engineer
at HGA, says staff input was critical to Lean
thinking during this process. Front-line
providers have insight that informs realistic
variation, which makes the model more
believable and less theoretical.

experience, because value is defined by what the customer values," says
Kevin Ortner, director of transformation operations and transition at
MetroHealth. "Otherwise, you're just making it less expensive, not necessarily better."
The I-Team analyzed suggested best practices using a three-step process: defining the problem, brainstorming seven ways to solve the problem, and analyzing the solutions via quantitative methods (such as time
and motion studies or return on investment) and qualitative judgments
about what would best enable the ultimate patient experience. On difficult
or controversial issues, the team members used force ranking exercises,
which involve establishing evaluation criteria, individually voting on
what's most important, and building a consensus. This process stimulated
meaningful conversation and helped the team arrive at decisions.
One patient and family need identified from this process was access to
information and services. To address this, the team created a concierge
service space for patients and families in a planned Patient and
Family Center, which serves as a one-stop hub for information on area
amenities (restaurants, hotels, transportation); services such as home
care; education and information on therapy and support groups; and
connections to other patients and care teams. The introduction of this
shared space supports Lean and universal process-neutral philosophies
and allows the reduction of dedicated or specialized education or waiting
areas on patient units.

L AY E R I N G O N E X P E R I E N C E

Universal concepts also must support a great
patient experience, so in collaboration with
MetroHealth's in-house Patient and Family Advisory Council, HGA reviewed extensive
surveys and interviews that were conducted
in 2014 to define the ideal customer experience. HGA benchmarked the narratives against
best practices to identify gaps, then took this
information and applied it to the patient experience journey across the proposed universal
platforms. "Any opportunity to create Lean
operational savings by eliminating waste in
the process must be in service to the customer

DECEMBER 2018

THE LONG TERM

As the project progressed through design, the team continued to consider
how design concepts must change to support the universal concepts being
implemented. This ultimately affected every system in the building, and
careful coordination across each piece was necessary.
For example, a 250-bed universal med/surg/ICU platform was created
that can flex over time, based on changes in patient acuity and service
volumes. The building itself and its infrastructure exhibit careful
attention to structural grid spacing and vertical floor-to-floor height to
anticipate unknown future technologies. Spaces are zoned by aligning
mechanical and electrical infrastructure areas as well as aligning clinical
and support areas. This provides open floor plates that can be adapted to
future platforms.
In departments such as lab, pharmacy, and staff areas, demountable
partitions are used to deliver adaptability for changing technology.
Additionally, clean/soiled/waste flows and spaces are programmed and
designed to support the desired future use of AGVs.
The resulting hospital elevates MetroHealth's best practices; provides
a technologically advanced and compassionate patient-care experience;
and creates a cost-effective, sustainable, and patient-focused hospital.
This transformation will support MetroHealth's ongoing mission in the
Cleveland community and enable it to adjust to the rapidly evolving ways
that healthcare is being delivered for many years to come. 
Kurt Spiering, FAIA, ACHA, is a principal and healthcare market sector
leader at HGA (Milwaukee). He can be reached at K S P I E R I N G @ H G A . C O M .
Mark Bultman, associate AIA, is a principal at HGA. He can be reached at
M B U LT M A N @ H G A . C O M .

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Healthcare Design - December 2018

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